HomeMy WebLinkAbout160 22ND ST - Building Permits _ •
�' CITY OF COSTA MESA
4 � @@ BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
0. PERMIT
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(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 160 22ND ST Status: FINALED
Suite No � Applied: 01/29/2004
®Vicinity: w ISSUED BY: Issued:
Parcel Number: 42606118 �
Applicant WOODS, BRETT AND JILL IAN
Address: 160 22ND ST
Phone: 949-514-9988
COSTA MESA,CA Zip: 92627
Owner WOODS, BRETT AND JILL IAN
Address: 160 22ND ST
Phone: 949-514-9988
COSTA MESA,CA Zip: 92627
Contractor:
Address:
•
Phone:
Zip:
License:
SCOPE OF PERMIT
ADD 314 SO. FT. SINGLE STORY MASTER BEDROOM.CONVERT ONE EXISTING BEDROOM TO
MASTER BATH. MECHANICAL TO INCLUDE: DUCT WORK, 1 VENT FAN (SINGLE DUCT)
REF:B04-00267
FEE SUMMARY
Quantity Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0
Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0
Ref rig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
116.•
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number:
(This section need not be completed it the permit is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit Is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOUARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and efect.Lia e — Classat : #
Contractors Signature: Date:
1 l
CONSTRUCTION LENDING AGENCY: � ]]//rr((�
❑ I hereby affirm that there is a construction lending agency for the performance Dfthetw dor is s permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more Than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). •
O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. 0 Yes ❑No Drivers License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bit or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has e
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
.._3 cupannedpepa�._ _ doa_
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a$$ermit for such construction or modification
from the South Coast Air Ouallty Management District or from any other air pollution control district or agency? IJ Yes t-J No
(Section 65850.2 of the California Government Code requires that the requested information bo furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which Is the subject of this
application,have at of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No
8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:1 certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
Signature Of Legal Owner(s) Date
And/Or Authorized Applicant Date
;ODE F. INSPECTION IYPE PATE INTRIALS CODE! INSPECTIONTYPE ;rllF 1 4SI
1616 Fixed System Final Fire Prevention 206 Final Mechanical `01144
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof _ 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
1
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0
Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0
Vent Fan/Single Duct $7.25 1 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance $0.00 0 Boilers
Fire Dampers $0.00 0 Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0
Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0
Floor Furnace $0.00 0 Other Mechanical Fee
Floor or Suspend Heater $0.00 0 Investigation Fee $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
TOTAL CALCULATEDFEES $44.45
COMMENTS/SPECIAL CONDITIONS
ADDRESS OF BALDING)I
160 22ND ST LINT: OF COSTA MESA — BUILDING PERMIT
OWNERS NAME IF OathIRSTEN CHALLMAN PERM NO: B 08457'
' k ADDRESS 160 EAST 22ND ST
COSTA MESA,CA 92627 PERMIT NO: B 084576 PLAN CHECK NO: N GOVT: N SUPP: N
r "" NGADDA CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT
ARCHITECT ORENGIIEER: arc.NG: JOB DESCRIPTION : T/OFF 6 REROOF W/COMP SHINGLES SQ FT: 1 , 500
ARCH.OR EMI ADDRESS: WIT:
CLAIM VALUE: 1 , 500 . 00 CALL—VALUE: 1 , 500 .00 GROUP OCC: R-3 /
CDIDRACTOR'S NAE
CONTRACTORS WADED COMMENTS: REROOF 1900SF RESIDENCE W/COMP
ADDRESS: LIC NO: ********4*r**r*****r*r'******************r****r******r*r*****iir***********is*****
MT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby Slim under penally of perjury Nat I am licensed under provisions of Chanter 9 SETBACK S
(commencing with Section 7000)of Division 3 d the Business and Prolessiorre Code,end my Ilcer"e is in lull leu and died.
CITY DC.NO.: LC.CLASS: UC.NG: EXP: MAIN BUILDING ACCESSORY BUILDING
Done: Contractor: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally d perjury that I am exempt from the Contractors License Law for the
following reason(Section 7031.5 Business and Any PARKING REQ: PROV: PARCEL : 42606118 ZNE: REF NO:
rnolpermit h,or repai any structure.prior to is Issuance,also requires the applicant for such peto file a signed statement thathe or she
owned pursuant to the provisions d the Contractors License Law[Chapter 9(commencing with Section 7000)d Dirlson 3 ot the PLANNING NOTES>
eines and Professions Code)or That he or she is exempt therefrom end the basis for the alleged exemption.My`Adeline'd Seebn >
(031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than Tire hundred dollars MOOD. ******************rsi**************r********rr**********rrr*rr*r******r*rrr*r.**r
0 I.as owner d the properly or my employees with wages as that sale compensation,all do the work,and the etmcture Is nd intended DEVEL OP MEN T SERVICES REQUIREMENTS
or offered for sale(Section 7044.Business end ProfessionsCode:The Contradors License Law does nol apply to an gamer d popery
who bunds or improves thereon.and who does such work himself or herself or through his or her own employees.provided INN such
nve
impments ere ml intended or offered loreale.It,however,the balding or improvement is sold within one year of completion,the ZONING APPROVED BY DATE:
rim ownerbuildar wig have the burden dawing phe or she dd sol build or improv lar the papoee d sale),
u Proms Cob::The Contractors Licenseclusively Lawdow with licensed contractors esno apply b en„sew01Nowa wo athstrud hobuu'ildss or irwentthteiSection ea,wand w'ndno BUILDING APPROVED BY : DATE:
contracts ler such projects with a contrwor(s)licensed pursuant to the Contractor'License Law).
I em exem''yy//under Section: B.&P.C..for Nig �I //JJ // I APPLICATION ISSUED BY: DATE: iQ L9�
/ O /�� �,. W A **********************”*IT+tXh9tit FjCE Eft rt')F***sin.'lt 9fA E'y(•ti ft li ft')t�f Yi�f')f]i ii YF�t ii li li-RT fl.TYc 3tM ENT: {f'
/T Dme: / LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
I do hereby certify that I am aware d and understand the Cali.. Siey Sad 25505,25533.and
25534,and that I or any Mune building aapam win/will not(circle eon) to comply cot said sale codes and requirements b
a permit la or
construction modification from tedi uZlyrel
Aglamenl r'.. .,Rowea&wmmdon appiretiaroara exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
prpuw°^' PERMIT. 48 . 50 . 50
Data Applicant: SMIP/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty d perjury one d the losowdrg dedveluns: PLAN
(hoand d Imainan a certificated consent to self-insure for workers'compensation.es provided for Swim 3700 d ab
the Lor ISSUE FEE
Code,tortheperformancedlhewmlewhichthispermitisieaued. BUILDING DIV > PERMIT ISSUE PLAN CHECK TOTAL PAID DUE
❑ Ihaveend wig malnreeslo
nworkers'oompenninwranoe,asrequiredbySediona
370OteLabor Code,laar
theperformweated TOTALS > 49 . 00 O . GO 0 . 00 49 . 00 49 . 00 UO
work to which this permit Is issued.My workers'compensation insurance carrier end policy number we:
Carrier: REVENUE DIVISION TOTALS--> COLLECTED: 49 . 00 OVER/SHORT; . 00
Polley Number: BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK '
,,fie aedlon need red be completed i the perml is for one hundred dollars 01001 or/oes.) 48 . 50 . 50
❑ I ceniy that in the performance of the work for which this«noel is issued,1 stalled employ anY Parent in any manner eq as to
become subject to the workers'compensation laws of California and agree that i =M
ed should become sed to the waken' **********ii************************lilt******************************4*ra********
compensation provisions el Swim 3700 d m,the Labor CoI Shan forthwith comply with those provisions. INDIVIDUAL F E E BREAKDOWN
Date: Applicant:
Warning:Failure to secure workers'conpeneanon«vera«la unlawful,and shall sublet,an employer to aiming;penales and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
c/vll Das up to one hundred thousand dollars(4100,000),In addition to the coal of compensation,damages es provided ler in
Section 3706 of the Labor coda,Interest,and attorneys feSFR 1500 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 500 . 00
CONSTRUCTION LENDING AGENCY:I hereby elfin under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which the paint Is issued(Section 3097,Civ.C).
LENDER'S NAME: • �.D
Le reed
ed the
ADUction E)T ETI( D�-T
end stale
laIhawng t bump construction
nthetedabove information myise awned,tepee Igc uwithell crycoolawayeddiarcey lj'j•I li LL
end done dews urpos "pdleig corWrudipn and heebY auAlores reeesepeNm d this coy to enter upon 1M ebwsmeaiswd property
la inspection pupoese.
KIRFTEN CHALLMAN DATE 89 23-1997/0;19 Aid/549.8;
Print Name 19 } T:084L576
7. Dale: eirt p09::17119917/T08::
Ek7'�I
ViSrt('
alO neer/Ag«VAppirant/Codrwa
(5151-45 W P) Wise-Buidkg A Soley:Green-i e:Canary_Appleant;Pink-Revenue:Goldenrod-Assessor
CONST RUCTION AND PLANNING POO .PA
-APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4, Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58: Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd.
10. Structural Floor System 61, APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing • 65. Electrical-Final
15. Rough Electrical-Conduit - 66. Solar System-Final
16. Rough Electric Wiring - 67. Fencing & Access Approval
17. Rough Wiring Sign ' . ` - 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling - 69, POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing n. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT •
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: �
34. Final Heating& Air Conditioning •
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42, Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING -
48. FINAL PLANNING
491, Electric Release to Edison •
50. Gas Release to Southern California Gas Co
_51. CERTIFICATE OF OCCUPANCY
No. Date
AODRFSSOpSMLWG: bU 12ND ST wet CITY OF COSTA MESA - BUILDING PERMIT
OWNERS NAME IF IDIOM'TE KIRSTEN CHALLMAN PERM NO: B 08443`.
ADDRESS: 160 EAST 22ND ST
ti l COSTA MESA,CA 92627 PERMIT NO: B 084439 PLAN CHECK NO: 03502-97 S GOVT: N SUPP: N
APDL MMIINO.ADORESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: ALT
•
ARcxREcraR ENaxEEx: UC.NO.: JOB DESCRIPTION 135 LINEAR FEET OF 6 ' HIGH BLOCK WALL SQ FT: 135
ARCH.are DIGS ADDRESS: UNIT: CLAIM VALUE: 8, 000 . 00 CALC-VALUE: 2, 700 . 00 GROUP OCC: R-3 . /
CONTRACTORS NAME;
COMMENTS: BLOCK WALL PER CITY STANDARD
CONTRACTORS MMDIG *************************************************************1i************it**,ti*
ADDRESS: Mc N0 ZONING REQUIREMENTS
wit SETBACKS r.
LICENSED CONTRACTORS DECLARATION:I hereby df oder perWy of perjury that I ern fioensed under provisions d Chapter 9
(oommendng rilh Section 7003)d Division 3 d the Business and Polesi«5 Code.and my Lanus is in 1 end Wed.
CITY UC.NO.: LIC.CLASS: UC.NO.: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: Ctaaed= LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I honey demi under penal),d perjry the l an exempt ban the Contractors License law for the PARKING REQ: PROV: PARCEL : 42606118 INE: R2MD REF NO:
Tdbwip reason(Section 7031.5&Rime and Proles:ods Code:My by or county which nrS to a permit to construe.altar,e a she
demolish.«neper any thestructure,prior o b isrntradols retakes the apeman for such perme to Ree signed steamer'that he a she PLANNING NOTES> 6FOOT HIGH BLOCK WALL ALONG RIGHT PROPERT LINE, 20 ' BAcK FROM
licensed(rumen to the pr(rmms d the Contractors License Law[Chapter 9(commencing with Sedan Taal)d Division 3 d the > FRONT PROP. LINE. -
031-5b and Pra erl Code]or that he ache u exempt a therefrom ad the base for the degeddremplion.Airy vpWon of Sete, ******************r'************************************************************
]W 1.5 by any eaters Ta a Penna subjects the applbant exemo a dvi penalty d nit more than be hundred ds(sr(55001).
❑ I.eowladthe presedy«myempga.ewith wawa atheir sole compensation,ea do the work.and the saucer*enot intended DEVELOPMENT SERVICES REQUIR EM EN -1 S
cc offered or sae(Section 70u,Business end PmlessionsCode:TheCoreractors License Law doe not applytoan owners property
who bulb a Somme,thereon,and dr doe such wok tinsel a hens(a trorrgh les a her own emplcyess.Provided the such "
improvements we nit intended I. th
lerdedoroffered for.. .Orhowever. e building or inprovemrsd Rone mpl
gold within year the ZONING APPROVED BY DATE:
X owrcrba'Ider wig have the burden of proving he a she cid not bald or improve for the pupae d We).
❑ Im(Amer d the crawly.am exdurively codtati g with licensed contactors to-• .• project(Sedan . .&Riness and BUILDING APPROVED BY : �/ DATE:
Professions Code:The Caredons License law doe oat'poly to an owner d papedy Ehvlds a• . . .•. thereon and who
contracts for such projects with a contrad«(s)licensed Pursuers to the . . ,... .Law). A
APPLICATION ISSUED BY: �/ DATE: 57
❑ I am exempt coder Seder. B.'B P.0 ��� *********************e*********1t A * 1t 141s+s3F******33**************ter* 3:le*-it *14
21
4-4Aetg -3 a .. %a��� Jg LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
Ido hereby cattily to l am sere d ad uderatand the ...' d ( �• '. .'... 25505.IISSD3,and
255&ad that I whiter°occupant w3°I suer not one)need.. .'! Inlaid Mate codes.. . requirements for BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
ns
apanne lorc( ort
uon or modfmon boml»M an
Quaky Management a',.'•.- mMa
el eppieateme . tmmuhw PERMIT 74 . 7550
1330333333
SMIP/NON-RES
Date: AppiCeft` PLAN 48 . 59
,
WORKER'S COMPENSATION DECLARATION:I hereby affim under penally of perjury one of "Cowingthe owh"Cowingdecimeters: ISSUE FEE '
❑ Ihave and wlminter acertificate dconsent tosalk S.orworkers'mpanseion•aprovided for bySection ITWdthe Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK • TOTAL PAID DUE
Code.tar the p.n« p
ma .dthace forwl:mtbp.m.islmu.d. TOTALS----> 75 . 25 0 . 00 . 48 . 59 123 . 84 123 . 84 . 00
❑ Have and MI mental waken'mnprmton Seance.as tgdM by Sedan 3100 of the Labor Code,or the prtatnre el the
work for rebel this pyre"issued.My warkrs'gmpermtioni ante Stier sod°°`anenber art REVENUE DIVISION TOTALS--> COLLECTED: 123. 84 OVER/SHORT: . 00
Carrier: BLDG PMT PLUMBING ELECTRIC MECHANIC - FIRE SMIP/TOT GRADING PLAN-CHECK
P" "am"" 74 . 75 y . 50 48 . 59
.Itis,Mon need not be competed l tperm*ool k kr one herded dollars' IS1WI or lest) s - .
❑ I certify that in the performance itis work for which Mrs permit is mhRd.I she not ern*"ary Peon in any manner gm to ************************ ******** ****' ******************** 4******************
become subject to thens
wakens compensation laws d agree aeee that I I should became tubed to the workers'
compo cation emersion.d Section 3700 d the Labor Cod..I shag forthwith campy with there praSi«v. INDIVIDUAL . FEE BR EAKD OWN
•
Date: API:Want
Warning:Four.to ecus weber cerpernadon corarepa la unlawful,and ah&subject t an employer criminalNe penaand TYPE QTY DESCR IP T I d' N - r UNIT COST TOTAL COST
dell fines cp to one tundras?thousand dollars(S104000),In atl&on to two coal of conprsatbn.damages as presided far In
SSFR 135 RES-CONCRETE BLOCK WALL / FT. 20 . 00 2, 700 . 00
cuon 3706 of Me Labe Cod.Wrest, stomsy s tea.
CONSTRUCTION LENDING AGENCY:I hereby affirm under panty of prau construction that there Mndre agency for the END OF FEES
perlamance d the work for which the ems is issued(Seton 3097.Cir.C). .
LENDER'S NAME
LENDERS ADDRESS: -•
I caddy the I have read the appf ...• and date the the above information is caned.I agree to comply with M dly and county ordinances r
ed state laws reeding to• ...' . .. ..• and hereyttvice representatives of the thy to enter upon the 113030-matloned property
fix inePedi°npn'°ma'. ;RS TACH.. .
88-27-1997/02:48 PH/3123.84
erSira L�r D1 Z� TR 084439
ds:l PEkt'lYT:084434
23.
'V
(5151-46.WP) WM1 ildie A Safety;Omen- rry
Du -Appiru:Pink-Revenue:Ooldeod-Assessor
CONSTRUCTION AND PLANNING POOL ,PA
APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. /J 57. APPROVAL TO COVER-GUNITE
7. Footings q18,1
07 /o 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing.& Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT.REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29, Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:flip Ann 47-471ega
34. Final Heating & Air Conditioning �jOv'e� 19,40 4,11-+`�
35.
Final Gas Pipe-Test !'/�(, r v/t����o,�,tea ,zrL � '�/
36. Hood or Canopy
37. Final Factory Fireplaces Vij/j411 .f� Y✓„�^ .
38. Final Plumbing ?//Z f.7 aa _ /;.Gnl.�/
39. Water Service-Final t/ Cy
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations Ate '
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING YY
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51.. CERTIFICATE OF OCCUPANCY
No. Date
DIVISION OF BUILDING SAFETY I
CITY CF COSTA MESA
•/
APP ItO.OVYD 6L143"�.
By / /4 //1565 Date g7a7�l) t Ott 504/24L 3
i
Thi4.n 4 [i I I t V ^• -1 L
s sc;c?Vic?, .a9[ _iio t:;uCT ba k: :c�,: t.:.,i ' i -_ 1 1N 1
,r :;at;c-a1:2o J:-1-ic11.IC:;:::::nit,: Ci.;',C::ycfCc_tnIl.:::::,
CITY OF COSTA MESA
pi.3clIn:ap'nnEadcp c: .::EnCI-5,i.C::Tbonc:ii?crr,-)c PLANNING DIV.
-at:Jcfin;f:c! :icaElcn Erolicm:1etan C::y0!c^a V."2::: SUBJECT TO BLDG. DEPT. REG.
ccr'' 3I 1.
aaf T./chnllexpo bytrr...E, cnNn 1 .,I�� ,. - BY"1�r7 DATE - 7
C_.0 ...I C. + ca enni cn::d4 df 'I B J- '' -
+=c�1__slalc �cr`^io\i�y ri- EQ��RFp..
��lMPy e�
11
.17
• 0
•b
*masa RESIDENCE RESIDENCE RESIDENCE
I.-
tai
W I-.
W W
It W
F. Ort
1 N
ao
I
•
STREET 6
1 60 as V - ,
TYPICAL 61I CONCRETE BLOCK FENCE •
7
Cement Coping Optional :7i lies
Channel Block With 1.3/80 F I u�so', GENERAL- NOTES
Horizontal Top of all
Fences i11111 MORTAR; One Part Plastic Cement, and
Ei Three Parts Sand
a GROUT: • One One PortHalf CementPFor Fences 5'or Less IartsSThrtandee and
Vens
. Bars 3/8"�at 4' -0"O.C. Id _ _ COPING: One Part Cement, Three
i LL pir � Parts Sand
For Fences Higher Than 5' f!i i
Ven. Bars 3/8"0 at 32" O.C. > w CONCRETE: Well Mixed 1:2—I/2: 3-1/2
cr = Max. of 7- 1/2 Gallons of
Fill Cells Solid With Groutflil > Z ' Water Per Sack of Cement
Where Steel Occurs > -Reinforcing Steel Shall I f mIIM GROUT MAV BE POURED FROM THE TOP
Conform to Sec.A-15-39 , w o - •• OF THE FENCE IN CELLS WHERE STEEL
f OCCURS.
A.S.T.M. i�� _ ~ -, '�E- CELLS AND AREAS OF HORIZONTAL REIN-
w rn ■ FORCEMENT SHALL BE CLEAR,CLEAN&
All Steel to be Lapped 1� u. 1 — - If FREEREE OF OF ALL MORTAR DEBRIS,ETC.
24"or to Code N
NATURAL GRI' v v ' ' 1111
• :/Ai>.: .Cp' 1,1° p . n a- ' 1 . . • - -cs
A -
TWO 3/8'"0 BARS 'Q� D - t - b . . . • . ♦ MEM ♦ e
CONTINUOUS TOP 1
&BOTTOM - 1 1-0—WIDTH • . TO 16' 0. C. MAX.
SEE CHART ♦ ♦ o_
HO4277.-STEEL MUST BE TIED IN BELOW DE PTH GF E ARTHTCOTH
PLACE AT TIME OF TRENCH e-I . t . '/3 THE HEIGTH OF FENCE
INSPECTION. • Lli
E A • FLOW BOTTOM OF FOOTING
;4
1_...1(2:0 2" 1- SCALE: I/2H : I.
i'.;, FOOTING REQUIREMENTS CHART
WALL HEIGHT - , I . 6 ' 5 4' 3'
WIDTH . . : . . . . . •. 1-': ' . 14" 14" 12" . . . . . 12"
THICKNESS 10" 10" 8 " , 8 "
DEPTH OF EARTHTOOTH . . 24" . . . . . .20" 16" . . . . 12"
• . SPACING OF EARTHTOOTH. 12' 14' 16'. . . . . . . 16'
City of Costa Mesa, C•
alifornia
Building Department
!ZFV.ISED Nov.St
•
Applicant to fill In all spaces except those within heavy border lines and sign all approorlate declarations.
CITYOF COSTA MESA PERMIT NO. TRACT NO. LOT NO. BLDG.NO.
-- CONSTRUCTION PERMIT . , l F' 2593 �: -
a .4920 R/31/y: F.,ei Ti
Applicant's h'�ailing Addrrg_ss ` �•. TYPE OF CONSTRUCTION NEW U ADD .0 ALTERATION -LF�EPAIR - .
Project Address //' /�O 'c c srCOS, A /11 A 0 CONVERSION 0 DEMOLISH ❑ OTHER - .
Owner'SName "' ' ��_ Phone 44 c3647 DESCRIPTION OF WORK
//�� ^ r _ ZONING REGULATIONS
Address / G� Z z S. TYPE OF PERMIT2......0 GRADING ❑ FOUNDATION- ❑-STRUCTURAL A.P.4' ZONE
Arch/Eng. License No. ❑ TENANT /ELECTRICAL ❑ PLUMBING ❑ MECHANICAL PLNG.REF.# ' -BUILDING- - '
/.� ❑POTHER - TO BUILDING ecrRnrk (VI CT
Address'
Contractor's Name O/�-/ . Phone PROJECT DESCRIPTION SQ.FT. OCCUPANCY PROPERTY LINE REAR YARD(TO P/L) -
Address(mailing)
CON STRUCTION TVPF VALUATION$ LEFT SIDE YARD RIGHT SIDE YARD
ZONE GRADING CU.YDS. ACRFS PKG.SPACE REQ. PROVIDED •
License No. __ - •
LICENSED CONTRACTOR DECLARATION -
Remarks: STREET WIDTH PARK FEE$ .
I hereby affirm that I am licensed under provisions of-Charter 9 (commencing .
with section 7000) of Division 3 of the Business and Professions Code,and '- SPECIAL CONDITIONS: .
my license Is in full force and effect.License Class Class License No. PLUMBING ,
• Date • Signature Bar Sink Sewer CapELECTRICAL
WORKERS'COMPENSATION DECLARATION - .'
`ereby affirm that I have a certificate of consent to self-insure or.a certificate . - Backflow Preventer - - Sewer Connection Automatic Washer ... Meter Dover 10b.amps , -
Workers' Compensation Insurance, or a certified copy thereof (Section - - • -
Backflow Irrigation Solar Collectors Construction Pole Sub Panel
J0, Lab. C.) •
Policy No. - Company ' • - Cooking Unit Sub Pole I I
8 Certified copy is hereby furnished. ; : i Bathtubs I ' Solar Piping
Certified copy is filed with the City Building Division. • Dishwasher • I Motors Do-1 HP 011/2-8
Date • Applicant I • ' Clarifiers Solar Tank .
EX IO N'F ROM WORKERS'COMPENSATION DECLARATION - Dryers ❑Gas' ❑Electric .Inc.Solar:D9-15 HP D16-15+
s section need not be completed if the permit Is for one hundred($100)or f ' ishwasher Swimming Pool w/Spa
I certify that in the performance of the work for wgich this permit is issued, I Drinking Fountains Urinal ' - '� Fen Microwave
shall not employ any person in any manner so . to become subjectto theFAUPole Light
Workers' Compensation Laws of Calif•rn . Floor Drains, Water Closet F.A.U.
. .
g
Date Signature :4S / Aar ' - Fixtures .
•
NOTICE:If,after making this declarat • , you-should beco e subject to the- ' Floor Sinks- . - Water Heater - - - - -• Range - . . _ .
Workers' Compensation provisions of the Labor Code,.y.tiu-must forthwith ' _ - - Device Boxes '
comply with' such provisions'or this permit shall be deemed revoked. Gas Service Outlets; ' ` .Water Service - ' Sign ,
CONSTRUCTION LENDING AGENCY - - Outlets '
i hereby affirm that there is a construction lending agency for the performance Interceptors _ • ' Standing Sections ' ,
of the work for which this permit Is Issued (Section 3097 Civ. C.) - • . Switches •
Lender's Name ' ' - ' Kitchen Sink • Trash Compactor '
Lender's Address' - - - -
OWNER.BUILDER DECLARATION . Lavatories •
Garbage Disposal
I hereby affirm that I am exempt'from the Contractor's License Law for the p-Tea Generator ❑0-5 KW D5-15 KW
following reason (Section 7031.5 Business and Professional Code: Any city or - p
county which requires a permit to construct,alter,Improve,demolish or repair - —� - Transformer 015-50 KW -
•
any structure, prior to Its Issuance, also requires the applicant for such permit Roof-Drains - -�
to file a signed statement that he/she is licensed pursuant to the'provisions of I ' ' ' . ' -. 050+KW. -
the Contractor's License Law.(Chapter 9(commencing with Section 7000)of 1- I - Reinspection Fee ! $15
Division'3 of the Business and'Professions Code) or that he/she is exempt Jl Showers • Reinspection Fee ' $15 • -
; _gefrom and the,basis for the alleged exemption. Any violation of Section / Meter to 100 amps Issue Fee .$ 3
"7-halt of not moretlhan five hundred hollert for a'permit s($505.the applicant to a civil , -Service Sink . ; 3 -'
y ($500). . , - Issue Fee $ Zoning Approved By Date
' 0 I, as owner of the'proper • or my employees with wages as their sole - '
compensation will do the work,and-the structure is not intended or offered ' _ MECHANICAL' 1 -Application Approved By - • -Date 1
for sale (Section 7044, Business and Professional Code: The Contractor's _ p -
License Law does not apply to.an owner of a property who builds or improves Boiler , "- . ' ' • Refrigeration System • Application Issued By ' ��/�j
employees, who tloes such work himself/herself or through his or her own PP � 'Date •
employees, provided that such improvements are not intended or offered for • 1:10-100,000 BTU ❑100,000 BTU'
sale. I/ however, the building or improvement is sold within one year of com- Duct-Under'Ground ' SUMMARY OF FEES '
pietist the owner will have the burden of proving he/she did not build or im- -
o for the purpose of sale). I Duct-Structural System Repair/Alteration • BUILDING PERMIT $ •
• PSMIP $ '
• I,as owner of the property, am exclusively contracting'with licensed con- - -
tractors to construct the project (Section 7044,Business and Professions Code: Duct.-Ventilating. . - - _- _ PLAN CHECK'
The Contractor's License Law does not apply to an owner of property who - - $ ISSUANCE $ I
builds or Improves thereon,and who contracts for such projects with a con- - Exhaust'System D Multiple D , • ' PLUMBING $
tractor(s) license pursuant to the Contractor's License Law).. PLAN CHECK $ GRADING $
D 1 am exempt under Section & P.C.for this reason ' Firepl/Fact.BIt. ICBO# ' •
•-pp $
r - - ELECTRICAL $ O " )
' Date ai P6Owner './J:•; � • Heating System&Ducting MICROFILM- $
.I hereby cmtify at I have readp• - - - -- -- • PLAN CHECK
-o Is a with all and•sta' the above DD-100,000'BTU•❑100,000 BTU $
information Is correct. I agree to comply all cityhand c • y ordinances - ( TOTAL1FEE ' $
.and state laws relatin•dt buildingenterconstruction,and hereby thorize repre- - - MECHANICAL $ • '
sentatives of this it. enter upon the above-mention•• operty for I Hood or Typel ❑ , i r 1 '
P Reinspection Fee• $15 LESS
inspection o .- �je- • ! Canopy Type I D PLAN CHECK $ •
Signature ✓%I�ia�^ _„. - Da Date ir i ADVANCED PC $
Drivers' Llcen - o •
- • -- /'__ Registers _ I Issue Fee $ 3 ' FINAL FEE $ d4- -
CMF 0865-46 rev:12/82 White-Building; -nary-Applicant;Pink-Accounting;Goldenrod-Assessor
• ; CONSTRUCTION AND PLANNING POOL A
Fgt Date Inspector Date Inspector
APPROVALS ' Permit# �- APPROVALS Permit#
1. Temporary Electrical Service or Pole • 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. ' • " . 53. Steel Reinforcement •
3. Electricbl Conduit Utility-Undrgrnd. 54. Forms •
4. Electrical Conduit-Undrgrnd. • - • 55. Electrical Bonding -
5. Steel Reinforcement • • 56. Rough Plumbing& Pressure Test
6. Electrical LIFER Grnd. . 57. APPROVAL TO COVER-GUNITE.
7. Footings - • 58. Electrical Conduit-Undrornd.'
•
8. Foundation - - 59. Gas Pipe, 0 Undrgrnd.,Test-
9. Water Pipe-Undrgrnd. - 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System - , 61. APPROVAL TO DECK -
11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final
12. Sewer Cap63. Heater&Went-Final - - •
13. Roof Drains - • = 64. Plumbing System - Final
•
14. Rough Plumbing 65: Electrical-Final •
15. Rough Electrical-Conduit . - 66. Solar System-Final •
16. Rough Electric Wiring - ' • _e 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro
22. }ucts, Ventilating • 71. Product Piping ❑Gas ❑Oil
23. Las Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank O Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structuralli& Monocoat 75. Dry Chemical
27. Frame and Flashing - • 76. Dry Standpipe
28. Lathing& Siding . 77. FIXED SYSTEM FINAL
29. Insulation ' 78. FIRE PREV. FINAL
30. Drywall Nailing Notes:
31. Plaster Brown Coat
32. Electrical Power Meter-Final 7,{j y If°
•
33. Final Electric 1'/frfit ifU
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test --
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing -
39. Water Service-Final
•
40. Gas Service-Final •
41. Solar Domestic-Final •
- -
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System - " - -
45. Sound Attenuation - -
46. Handicap Regulations I •
•
•
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed - •
49. Electric Release to Edison . • .
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No Date